The 8th Annual University of Pittsburgh Symposium on Regenerative Rehabilitation (24–26 October, Charlottesville, VA, USA) brings together internationally renowned researchers and clinicians working in the emerging field of regenerative rehabilitation. Regenerative rehabilitation, which bridges discoveries in tissue engineering and cellular therapies and rehabilitative treatments, encourages all stakeholders to work together for improved patient outcomes.
I spoke to session chairs and other speakers from this year’s event to give a sneak-peek of what attendees can expect.
How could regenerative rehabilitation address current treatment challenges?
Joe Hart (Associate Professor of Kinesiology and Director of Clinical Research for University of Virginia (UVA; VA, USA) Orthopaedics), session moderator: A combination of innovative therapies with a strategic approach to post treatment rehabilitation is paramount. The injuries and problems facing those with severe injuries are multifactorial - so will be the treatment approaches. The current energy around solving these problems is truly impressive and I’m glad that UVA has the opportunity to contribute.
Quanjun Cui (G.J. Wang MD Professor of Orthopaedic Surgery, Vice Chair for Research, UVA), session moderator: Many musculoskeletal (MSK) disorders that affect the muscles, tendons, bones, and joints in the human body are difficult to treat, such as large bone defect from sever trauma or resection of tumor, osteonecrosis (dead bone) of the femoral head caused by steroid treatment or alcohol abuse, degenerative joint disease (damage to cartilage), just to mention a few.
There are many breakthroughs in the field of regenerative medicine which use cells, biomaterials and growth factors to fix structures in human body that do not function properly due to disease or injury. Regenerative medicine in MSK treatment is promising; for example, bone marrow derived stem cells can help to heal delayed or non-union fractures. However, only a handful of breakthroughs have made it from bench to patients.
How has the field of regenerative rehabilitation advanced in the last 8 years?
George J. Christ (Professor of Biomedical Engineering and Orthopaedic Surgery, Mary Muilenburg Stamp Professor of Orthopaedic Research, Director of Basic and Translational Research in Orthopaedic Surgery, Co-Director, Center for Advanced Biomanufacturing, Laboratory of Regenerative Therapeutics, UVA), co-chair of the scientific committee and session moderator: In my opinion the biggest advance has been increased communication, collaboration and integration of diverse areas of scientific expertise and patient care. We are having novel and more informed conversations at this meeting, and they now extend and continue beyond the meeting timeframe to result in more prolonged and consistent discussions throughout the year. This has really pushed the field forward.
What are the challenges in translating regenerative rehabilitation and bringing it to the clinic?
Shawn Russell (Assistant Professor in Orthopaedic Surgery, UVA), speaker: I am speaking in the session Regenerative Rehabilitation Takes an Eye to the Clinic. This talk will demonstrate how we are taking methods developed for the analysis of human movement and translating them for use on rat movement function. Rats are often used as small animal models to understand pathologies and treatment. We are using these methods to understand how volumetric muscle loss injuries are not just limited to reduction in force generation but also tend to include nerve and vascularization issues as well, helping us understand how these injuries change the kinematics and muscle loading of the rat motion affecting functional outcomes.
One of the challenges of regenerative rehabilitation is that often the injuries we are trying to heal are large and incorporate many different systems, such as muscle, nerve and vascularization. Trying to determine which part of the pathology is responsible for a specific change in function can be difficult to tease out from all of the data we collect.
Silvia Blemker (Professor of Biomedical Engineering, UVA), speaker: One important challenge is relating pre-clinical work done on animal models to clinical application in humans.
What are the unique challenges in treating service personnel and veterans?
Joe Hart: I am moderating the session Impact of Regenerative Rehabilitation on Warfighter Care. Injuries in this population are complex and severe with many confounding factors that can potentially affect successful outcomes. There are many problems to solve and it’s exciting to be a part of the innovation that will lead toward the solutions.
Why is it important to discuss this topic?
Shawn Russell: Movement data are important as they give us a way to quantify the recovery from injury. In the case of volumetric muscle loss, they let use see how the regenerative materials are incorporated into the animals’ function and verify that they are actually increasing the level of function of the animal. The data also lets us see how the in vivo conditions may change over time as the animal recovers. Understanding these changes in the environment will help inform the design of the regen technology; it will also enable us to optimize when, where and how the rehabilitation should occur for maximal functional return.
Silvia Blemker: Currently, the design of tissue engineering approaches relies on intuition of scientists rather concrete predictions made by theory. Our goal is to develop models that provide the field with underlying theories that will allow more informed hypotheses and ideas to be tested and expanded in the field.
What technology innovations or knowledge could help translate regenerative rehabilitation?
Shawn Russell: Having an effective method for quantifying the changes in function is the first step in identifying how individual aspects of a polytrauma are affecting functional outcomes. It gives us a platform to develop isolated injuries, measure the changes in function, then use that data to better understand the polytrauma and any regenerative technology interventions.
Silvia Blemker: I run the Multi-scale Muscle Mechanophysiology Lab group at UVA and am speaking in the session Regenerative Rehabilitation Takes an Eye to the Clinic, where I will describe our recent studies in which we applied computational modelling to inform muscle tissue engineering research.
What could the next 8 years of regenerative rehabilitation bring?
George J. Christ: I envision a continuation of current progress, perhaps even an acceleration, that when marked out over the 8 year time frame is going to produce dramatic changes in the way that we evaluate and treat, for example, traumatic extremity injuries (my area of expertise). Hopefully, this will result in personalized therapeutics and rehabilitation regimens to improve functional outcomes in a more predictable and reproducible fashion. But certainly, there will be a huge impact of this approach on any disease, disorder or condition that would benefit from regenerative rehabilitation.
What talks are you particularly looking forward to attending at the symposium, and why?
Joe Hart: I am personally most interested in talks about clinical or preclinical experiences with specific rehabilitation interventions after regenerative treatments. I’m also interested in clinical research design approaches to study ways in which outcomes can be optimized in treated patients. This is an important aspect of assuring the success or regenerative therapies. Strong research teams including robust study designs supported by clinical trials infrastructure is essential.
George J. Christ: Every year we bring in new speakers, with new perspectives and experiences to extend our network and our reach into new communities, institutions, companies, etc. This results in a growing ecosystem to support the advancement of the field, and moreover, to energize the participants to continue the discussions/interactions/ collaborations in the interval between meetings. So learning about all of the recent developments, getting current on the status of the field, meeting new people and catching up with old friends/colleagues are what I look forward to most of all.
Quanjun Cui: I would like to hear talks focusing on high-quality studies with quantitative methods for cell harvesting, processing, characterization, delivery, and standard reporting of clinical outcomes because these are important questions that we do not have a clear answer yet. As a clinician interested in regenerative medicine, I would like to meet with world class scientists at the meeting to seek opportunities to collaborate with them so we can team up to improve patient care through innovation and discovery.